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中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (10) : 779 -784. doi: 10.3877/cma.j.issn.1674-0785.2020.10.006

所属专题： 文献；

临床研究

低频与高频rTMS对帕金森病患者运动功能和自主神经功能障碍的影响
赵安容1, 李波1,†(), 徐世成1, 王莉2   
  1. 1. 636000　四川巴中，巴中市中心医院神经内科
    2. 637000　四川南充，川北医学院神经疾病研究所
  • 收稿日期:2020-03-29 出版日期:2020-10-15
  • 通信作者: 李波
  • 基金资助:
    四川省卫计委科研课题(17PJ400); 四川省教育厅课题(18ZA0212)

Effect of low- and high-frequency repetitive transcranial magnetic stimulation on motor dysfunction and autonomic nerve dysfunction in patients with Parkinson's disease

Anrong Zhao1, Bo Li1,†(), Shicheng Xu1, Li Wang2   

  1. 1. Department of Neurology, Bazhong Central Hospital, Bazhong 636000, China
    2. Institute of Neurological Diseases, North Sichan Medical College, Nanchong 637000, China
  • Received:2020-03-29 Published:2020-10-15
  • Corresponding author: Bo Li
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引用本文：

赵安容, 李波, 徐世成, 王莉. 低频与高频rTMS对帕金森病患者运动功能和自主神经功能障碍的影响[J]. 中华临床医师杂志(电子版), 2020, 14(10): 779-784.

Anrong Zhao, Bo Li, Shicheng Xu, Li Wang. Effect of low- and high-frequency repetitive transcranial magnetic stimulation on motor dysfunction and autonomic nerve dysfunction in patients with Parkinson's disease[J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(10): 779-784.

目的

观察低频与高频重复经颅磁刺激（rTMS）治疗帕金森病（PD）患者运动功能障碍和自主神经功能障碍的效果及安全性。

方法

将90例伴自主神经功能障碍的PD患者分为低频组、高频组及假刺激组。治疗组患者分别给予低频1 Hz、高频5 Hz rTMS治疗，假刺激组于相同时间点、相同部位给予假性rTMS治疗。于治疗前、治疗后即刻、7 d、14 d、30 d，采用起立-行走实验时间、统一帕金森病评定量表（UPDRS）和帕金森病自主神经症状量表（SCOPA-AUT）评分作为评定指标。

结果

组内比较：高频组和低频组患者治疗后即刻、7 d、14 d、30 d，起立-行走实验时间均较治疗前有所缩短，且差异具有统计学意义（P＜0.05）。低频组UPDRS评分、SCOPA-AUT评分在治疗后7 d、14 d较治疗前降低，差异有统计学意义（P＜0.05）；治疗后即刻和治疗后30 d与治疗前相比，UPDRS评分、SCOPA-AUT评分无明显统计学意义（P＞0.05）。高频组UPDRS评分、SCOPA-AUT评分在治疗后7 d、14 d、30 d均较治疗前降低，差异均具有统计学意义（P＜0.05）。组间比较：与假刺激组比较，低频组、高频组治疗后即刻、7 d、14 d起立-行走实验时间均缩短，差异有统计学意义（P＜0.05）。与假刺激组比较，治疗组UPDRS评分在治疗后7 d、14 d均降低，差异有统计学意义（P＜0.05）；至治疗后30 d时，与假刺激组比较，低频组UPDRS评分不具有统计学意义（P＞0.05），但高频组UPDRS评分仍低于假刺激组，差异具有统计学意义（P＜0.05）。与假刺激组比较，高频组、低频组患者SCOPA-AUT评分在治疗后7、14 d均明显降低（P＜0.05）；在治疗后30 d，低频组与假刺激组比较，SCOPA-AUT评分差异不具有统计学意义（P＞0.05）；但高频组SCOPA-AUT评分仍低于假刺激组（P＜0.05）。

结论

低频及高频rTMS均能有效改善PD患者的运动功能和自主神经功能障碍症状，安全性较好，且高频rTMS治疗可能较低频rTMS治疗作用更强、更持久。

关键词: 帕金森病, 重复经颅磁磁刺激非运动症状, 自主神经功能障碍, 运动功能
Objective

To evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in the treatment of motor dysfunction and autonomic nerve dysfunction in patients with Parkinson's disease (PD).

Methods

Ninety PD patients with autonomic nerve dysfunction were divided into a low-frequency rTMS group, a high-frequency rTMS group, and a sham stimulation group. Patients in the low- and high-frequency rTMS groups were treated with low-frequency (1 Hz) and high-frequency (5 Hz) rTMS, respectively, while patients in the sham stimulation group were treated with sham rTMS. At the corresponding time points before and after treatment, the unified Parkinson's disease rating scale (UPDRS) and the scale of autonomic nervous symptoms of Parkinson's disease (Scopa-Aut) were used to assess motor dysfunction and autonomic nerve dysfunction.

Results

Immediately, 7 d, 14 d, and 30 d after treatment, the timed up and go test was significantly improved compared with that before treatment in the high- and low-frequency rTMS groups (P＜0.05). Compared with the values before treatment, the UPDRS score and SCOPA-AUT score in the low-frequency group were significantly improved 7 and 14 d after treatment compared with those before treatment (P＜0.05), while there was no significant change in UPDRS score or SCOPA-AUT score immediately after the end of treatment and 30 d after treatment (P＞0.05). The UPDRS score and SCOPA-AUT score in the high-frequency group were significantly improved 7 d, 14 d, and 30 d after treatment compared with the values before treatment (P＜0.05). The timed up and go test was significantly improved immediately after treatment, 7 d, and 14 d after treatment in the low- and high-frequency groups compared with the sham stimulation group (P＜0.05). Compared with the sham stimulation group, the UPDRS scores of the two treatment groups were significantly improved 7 d and 14 d after treatment (P＜0.05), but at 30 d, the UPDRS scores of the low-frequency group had no significant change (P＞0.05), though the UPDRS score in the high-frequency group had a significant change (P＜0.05). SCOPA-AUT scores of patients in the two treatment groups at 7 and 14 d after completion were significantly improved compared with that of the sham stimulation group (P＜0.05). At 30 d after treatment, there was no statistical difference in Scopa-Aut scores between the low-frequency group and the sham group (P＞0.05), though there was a significant difference in the SCOPA-AUT score between the high-frequency group and the sham group (P＜0.05).

Conclusion

Both low- and high-frequency rTMS can effectively improve the motor dysfunction and autonomic nerve dysfunction symptoms in PD patients with good safety, and high-frequency rTMS treatment has stronger and more lasting effects than low-frequency rTMS treatment.

Key words: Parkinson's disease, Non-motor symptoms, Repetitive transcranial magnetic stimulation, Autonomic nerve dysfunction, Motor function
表1 低频组、高频组和假刺激组帕金森病患者一般资料
组别 例数 性别（例） 年龄（岁，
x¯
±s）		 病程（年，
x¯
±s）		 H-Y分期（期，
x¯
±s）
男 女
低频组 30 17 13 64.32±5.93 6.83±2.03 2.97±0.78
高频组 30 16 14 63.18±7.23 6.65±2.33 2.82±0.84
假刺激组 30 17 13 66.15±4.85 7.36±1.76 3.12±0.56
表2 3组帕金森病患者各时间点起立-行走实验时间比较（min,
xˉ
±s）
组别 例数 治疗前 治疗后即刻 治疗后7 d 治疗后14 d 治疗后30 d
假刺激组 30 11.97±1.79 11.89±1.78 12.30±1.46 12.24±1.18 11.96±1.73
低频组 30 12.36±1.29 8.28±1.77ab 7.98±1.21ab 8.78±1.01ab 9.21±0.31ab
高频组 30 12.12±1.11 8.24±1.01ab 5.59±1.08abc 7.87±0.98ab 9.02±0.36ab
F值 0.187 2.156 2.728 2.487 2.115
P值 ＞0.05 ＜0.05 ＜0.05 ＜0.05 ＜0.05
表3 3组帕金森病患者各时间点UPDRS评分比较（分，
xˉ
±s）
组别 例数 治疗前 治疗后即刻 治疗后7 d 治疗后14 d 治疗后30 d
假刺激组 30 47.54±6.96 47.94±6.85 48.63±5.01 49.08±4.53 47.88±6.69
低频组 30 47.72±6.13 45.72±5.33 31.56±4.23ab 32.18±3.28ab 44.45±5.12
高频组 30 46.98±6.94 44.98±4.97 24.19±3.18abc 30.87±2.76ab 35.94±2.43abc
F值 0.115 0.285 4.885 3.783 2.594
P值 ＞0.05 ＞0.05 ＜0.05 ＜0.05 ＜0.05
表4 3组帕金森病患者各时间点SCOPA-AUT评分比较（分，
xˉ
±s）
组别 例数 治疗前 治疗后即刻 治疗后7 d 治疗后14 d 治疗后30 d
假刺激组 30 25.16±3.74 25.23±2.65 25.96±3.01 24.75±3.25 24.77±2.69
低频组 30 25.48±2.48 24.86±2.98 17.93±2.31ab 17.47±2.48ab 23.36±2.74
高频组 30 24.98±3.51 24.91±2.81 16.56±1.98ab 15.97±2.06ab 17.59±1.43abc
F值 0.169 0.174 3.576 3.498 3.194
P值 ＞0.05 ＞0.05 ＜0.05 ＜0.05 ＜0.05
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